Danielle Babbel – OHSU StudentSpeakhttps://blogs.ohsu.edu/studentspeak
Who better than the students to describe what being a student at OHSU is all about?Tue, 27 Feb 2018 17:40:57 +0000en-UShourly1138385471Healthcare in a parking garagehttps://blogs.ohsu.edu/studentspeak/2013/03/29/4737/
https://blogs.ohsu.edu/studentspeak/2013/03/29/4737/#commentsFri, 29 Mar 2013 21:05:20 +0000http://www.ohsu.edu/blogs/studentspeak/?p=4737Continued]]>

Somehow the gravity of the words was diminished when translated into a second-language. “Tienes diabetes” (You have diabetes). It wasn’t until after I had said them, and after I saw the empty stare of the words’ recipient, that I realized the weight of the information I had just relayed. The make-shift office of felt walls and PVC pipes in the underground parking garage felt like an odd place to give someone a diagnosis of a potentially chronic illness. In that moment, the reality of health inequity was made clear to me.

Health Care Equality Week 2013

Though an organizer for this year’s Health Care Equality Week screening fair, I had a bit of patient interaction on the day of the event when I stepped in to interpret for Spanish speakers a few times that day. The annual event, held in downtown PDX, brought in nearly 300 patrons from the surrounding area. When I arrived for set-up at 7:30 that morning, many had already started forming a line, waiting for the gates to open an hour and a half later. As a multi-disciplinary and multi-university event, the screening fair featured a variety of services including oral exams, visual acuity screenings, diabetic foot care, immunizations, veterinary care, medical consult, blood glucose checks, and hair cuts among other things. Throughout the day, a steady stream of people seeking medical attention ventured into the damp, cold underground parking garage where the fair has traditionally taken place. Held in conjunction with Potluck in the Park, patrons could head above ground in the afternoon for a meal after the fair.

Like some of those who attended the fair, the Spanish-speaking person had come for a specific ailment and wanted to speak to a medical provider. He had been experiencing blurry vision and numbness in his feet. When his pinprick revealed an elevated blood glucose, the pieces of the puzzle began to fit. What seemed to bother him most about his newly acquired diagnosis was how we would pay for his care. He had been receiving regular check-ups until the last 1 or 2 years, and it was over this time period that his body’s resistance to insulin began. He didn’t know where to go. He didn’t have insurance and he didn’t have a job. He explained that because of an inability to find work in Portland, he thought he would have to move back to the Midwest. He asked what kind of medical care he could receive there. Explaining to him that I could not speak for that part of the country, I took him over to the referral table where he received information about being seen at the Virginia Garcia clinic. I urged him to call, giving him their number with a message to say that the OHSU health fair sent him.

I wonder today if he ever called, and if he was ever seen. So many in this country still slip through the cracks, and many preventable illnesses are left unchecked. Because he was faced with the challenges of unemployment and potential re-location, any barrier to access care would understandably be formidable. I saw that the health fair, just four hours on one day out of the whole year, was a chance to regain some that are lost. It was a chance for us as students to give back to the community. It was also a chance for us to see first hand the reality of health inequity in the United States. The office visits and routine screening that many of us take for granted are hard to come by for a large population in this country. Unfortunately, this same population also deals with a number of other stressors that come along with low socioeconomic status, further compromising their health.

The health fair was a great reminder that as future health care providers we must view community health as something intertwined with the other necessities of life–housing, employment, food, etc. To promote health, we must also promote everything that comes with it.

]]>https://blogs.ohsu.edu/studentspeak/2013/03/29/4737/feed/24737From Columbia 3: MetroSaludhttps://blogs.ohsu.edu/studentspeak/2012/07/19/from-columbia-3-metrosalud/
Thu, 19 Jul 2012 20:29:59 +0000http://www.ohsu.edu/blogs/studentspeak/?p=3923Continued]]>Danielle is spending five weeks in Medellin, Colombia working on a research project involving tobacco exposure in pregnancy. The project involves two surveys: one targeted to prenatal care providers and one for pregnant patients in four different medical institutions throughout the city. She will blog about her experience here at OHSU StudentSpeak. Learn more.

Wednesday afternoon took me to work at El Salvador, one of several clinics run by MetroSalud. The organization comprises a network of 35 clinics and 9 hospitals, all publicly-funded, throughout Medellin. MetroSalud’s sites largely serve a low income population, and are generally located in the city’s poorest areas.

I spent a few hours that day with Dra. Lina Montoya, assisting with her prenatal appointments. I immediately felt the difference between working at one of MetroSalud’s centers from working in a large academic hospital (Hospital General de Medellin). Besides the fact that there were not six other residents/students surrounding me and not everything was a talking point when examining a patient, El Salvador had a much different ambiance.

Dra. Lina seemed calm and relaxed, and left her door open during each visit. She spoke to each patient like a dear family member and affectionately called the pregnant ones “gorda” (which is not offensive in this culture). I have been blown away by the average age of the patients I have seen working at MetroSalud. Most have been under 18, and 15 seems to be a common age for the initiation of motherhood in this population. Tiny girls who you would not think could even get pregnant strolled in, sometimes accompanied with their young mother who appeared as though they also had given birth at an early age. I didn’t get the vibe among these patients that teenage pregnancy carried quite the stigma in their community as it does in the US, although Dra. Lina was well aware of and took into account the biological and emotional risks associated with early motherhood. It almost felt like the norm. Talking to Dra. Lina, I found out that MetroSalud offers free contraception methods through a program called Sol y Luna, including the pill, implanon, and even the IUD. Are these girls not taking advantage of these services because a) they want to get pregnant, b) they have not taken the time to schedule the visit, or c) they do not know about these services? The answer is probably more complex than any of these options. Part of me wants to crush up some estrogen and progestin and sprinkle it in the water here, though that might be sort of inhumane.

I am looking forward to seeing more of MetroSalud’s sites and continuing with patient surveys (which ask about their knowledge of and exposure to tobacco in pregnancy). Dr. Bernardo Agudelo, my liaison at Nacer, graciously gifted me the assistance of two other medical students from la Universidad de Antioquia, Tatiana and Laura, who will help me in survey distribution. Phew!

Spanish lesson for those in the medical field (or those that are just interested in learning lady-health related words in another language):

]]>3923From Columbia 2: A rock and a lakehttps://blogs.ohsu.edu/studentspeak/2012/07/12/from-columbia-2-a-rock-and-a-lake/
Thu, 12 Jul 2012 17:01:39 +0000http://www.ohsu.edu/blogs/studentspeak/?p=3818Continued]]>Danielle is spending five weeks in Medellin, Colombia working on a research project involving tobacco exposure in pregnancy. The project involves two surveys: one targeted to prenatal care providers and one for pregnant patients in four different medical institutions throughout the city. She will blog about her experience here at OHSU StudentSpeak. Learn more.

The wonders of Medellin can only be taken in doses, and I decided that I needed a break from the commotion of city life, so I fled to Guatapé, a nearby town. The main attraction of this town, as I read in my guide book, was a big rock overlooking a big lake. I didn’t look too much further into it, but when I visited Guatapé I found out that this description severely underestimated the beauty of these geographical phenomena.

I was dropped off after a 2-hour-ish bus ride at La Piedra (the stone, aka la Piedra del Peñol o Peñón de Guatapé), which lies about 15 minutes from the town center of Guatapé. I was not going to visit the rock until after dropping of my backpack and checking in at my hostel in Guatapé, but when the bus stopped at the base of the rock, and I saw it in it’s full glory (which cannot be captured by photographs) I could not wait. Backpack and all, I trekked the 679 stairs and 656 feet to reach its peak. It was well worth the 10,000 pesos and physical exertion, even with a backpack on. The view was incredible: a 360 degree vista of lake Guatapé and its many inlets and outlets. It was like looking at the blue green pattern of the earth’s surface from space.

A young man poses, on the precipice of the rock's highest viewpoint

The lake arose from the unfortunate construction of a dam which flooded the old town of el Peñol, and led to the construction of a new Guatapé. The new town would make up for the destruction of the old with its pretty cobble stone streets and multi-colored buildings. Strolling through Guatapé felt like a walk through Disneyland, with the buildings displaying not only color but little pictures on their facades.

The next day I accompanied three visitors from North Carolina I had met at my hostel on a bike journey via the backroad to la Piedra (as my hostel was on the opposite side of Guatapé from the monolith). Despite the mechanical difficulties my bike suffered (as rental bikes often have) and the incredibly bumpy dirt road we took, the journey was not to miss. The Norte Carolinenses and I traversed valleys and hillsides on our rickety old bikes in the glaring tropical sun of 7,000 feet for a couple of hours, and the views made up for any discomfort brought on by riding decrepit bikes. As we rode, I kept thinking to myself, “I love life.” There is nothing quite like being in the middle of nowhere on a bike in stunning lush country. The area reminded me a lot of Rwanda, actually, with its rolling uber-green hills and dry breeze. I have decided that the best of climates occurs with the combination of high altitude and low latitude, as is the case here and in Rwanda. Medellin, like Rwanda, is said to be a region of eterna primavera (eternal spring) because of the warm, but not too hot, and relatively dry (not humid like tropical lowlands) climate. Cuernavaca, Mexico, Caracas, Venezuela, Trujillo, Peru, and Quito, Ecuador are other cities that also carry this label.

The altitude of this pleasant ride, however, would manifest itself in less desirable ways, specifically the exertion of uphill riding as well as the sunburn I had at the end of the day despite slathering on SPF. After the tiring journey, we had lunch on the waterfront of Guatapé and I then very hesitanty hopped on the 5:05 bus back to Medellin. I did not feel ready to leave, and could have easily spent the next week there exploring more of the area’s natural pools and waterfalls, and waking up to a view of the rock over water everyday. Nevertheless, Monday morning would come no matter how hard I tried to freeze time in Guatapé, and I had to get back to work. I returned with a great appreciation for the tourist destination (visited by mostly Colombian tourists) and a plan to somehow return to the lake and rock before I leave this country.

Danielle is spending five weeks in Medellin, Colombia working on a research project involving tobacco exposure in pregnancy. The project involves two surveys: one targeted to prenatal care providers and one for pregnant patients in four different medical institutions throughout the city. She will blog about her experience here at OHSU StudentSpeak. Learn more.

Just as I was starting to forget why I have begun to incur thousands of dollars of debt and why come August my life of wander and reading novels will end once again, I began work at el Hospital General de Medellin. The morning I rounded with Dra. Mesa and her resident minions in the fifth floor’s high risk OB/GYN wing, I felt like I had come home after being on a brief but probably needed vacation away from medicine. I did not ever think that talk about toxoplasmosis and C-reactive protein would ever be music to my ears, but it has been great to feel knowledgeable about things I did not know even existed a year ago. Spanish has also started to feel like a language I know again, as its medical terminology overlaps so nicely with English. Street Spanish in Colombia is far more complicated than medical Spanish, and much harder to follow.

The patients we see at el Hospital General, as I mentioned above, have obstetric or gynecological complications that place them in the high risk category. Many of them are also of lower socioeconomic status and insured or subsidized by the government. It’s not uncommon that a patient will come for consultation in the afternoon after a 3-5 hour bus ride from a more remote community.

The population seen at el Hospital General necessitates some good history taking from each patient. I’ve already learned a bit about the more traditional methods of perinatal care in these remote communities. For instance, it’s been standard for women to spend 40 days in bed postpartum, as it is believed that in this vulnerable condition they should not expose themselves to the outside world for fear of cold (not that it ever actually gets cold here). Consequently, a lot of women develop blood clots in their legs (thromboses) after giving birth. Also, women have classically consumed large quantities of fatty chicken after delivery to prevent hemorrhage (in order to promote blood coagulation). Interesting stuff.

Today’s shift at the hospital began with a terrifying experience. I gave a short PowerPoint presentation to the residents during their early morning OB/GYN conference to promote the research project I am involved with here. My public speaking anxiety was multiplied by a factor of a second language, which equaled a large amount of stress the night before. The experienced turned out to be much less nerve-racking than I anticipated, however, and now I can breathe a sigh of relief to have one of these presentations over with.

The conference (people watching too attentively for my comfort level)

No babies yet at el Hospital General de Medellin, just many lady-parts and large bellies. Maybe soon one of them will pop at just the right time and I can see my second delivery (and first delivery outside of the US).

]]>3773Five weeks in Medellin, Colombiahttps://blogs.ohsu.edu/studentspeak/2012/07/05/3766/
Thu, 05 Jul 2012 17:54:40 +0000http://www.ohsu.edu/blogs/studentspeak/?p=3766Continued]]>Greetings! On behalf of Dr. Jorge Tolosa, MD, MSCE and recent OHSU graduate, Britt Severson, MD, MPH, I will spend five weeks in Medellin, Colombia working on a research project involving tobacco exposure in pregnancy. The project involves two surveys: one targeted to prenatal care providers and one for pregnant patients in four different medical institutions throughout the city. Besides promoting our project (through presentations to potential participants) and finalizing the survey instruments, I am gaining clinical experience in all four institutions. My whirlwind tour of clinical observation in Medellin will enable me to see the delivery of prenatal care as it varies throughout the city as well as how it compares to prenatal care in the US. In between all of this, I am finding time to explore the natural and cultural wonders that this beautiful country has to offer. I will post about my summer experience here at StudentSpeak!
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